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I can’t take the pill. What else can I try?

For women looking to avoid taking birth control pills, non-hormonal contraception is an option. Dr. Judith Reichman offers some guidelines.

Q: In the past I’ve had problems with birth control pills (headaches, irregular bleeding and bloating) and I’m looking for a form of non-hormonal contraception. What would you suggest?

A: There was a recent article in the OBGYN edition of The Female Patient, written by Sarah B. Freeman, that I thought gave a very good self-assessment checklist. Here are her recommenations, together with my own comments.

Freeman advises looking at your health profile to see if you have any of the following conditions:

  • Frequent urinary tract infections. The use of a diaphragm or sponge can make you more susceptible.
  • Frequent skin reactions or allergies. You might find you’re allergic to spermicides or have a latex allergy (most male condoms and diaphragms are made of latex).
  • Recent pelvic infections, such as pelvic inflammatory disease (PID) — especially if it occurred in the last few months. This is considered a contraindication for insertion of  IUD, especially if you’re not in a monogamous relationship.
  • Severe menstrual cramping. This condition is usually helped by the use of a birth control pill, patch or ring, especially if used in a prolonged cycle (in other words, two or three months at a time without breaking for your period). However, if you can’t or don’t want to do this, the use of a unique IUD — the IUS, or intrauterine system, containing slow-release progestin called Mirena — may reduce bleeding and cramping.
  • Heavy menstrual bleeding. Again, a slow-release progestin IUS often helps.

Freeman also recommends taking a look at your reproductive preferences:       

  • Are you planning to have a baby and if so, when? If there’s any chance you might want to bear a child in the future, do not consider sterilization. An IUD with almost the same effectiveness as sterilization could provide short (five years for Mirena) or long (10 years for the copper-containing Paraguard), reversible contraception. If you might want to have a baby in the next year, it probably doesn’t pay to choose these options, since they cost $400 to $700.
  • How important is preventing pregnancy? Barrier contraception has a higher failure rate with typical use in the first year. For example, if 100 women use a male condom for a year, 11 will get pregnant; with a female condom, 21 will get pregnant; with use of just a spermicide, between 20 and 50 will get pregnant; with a combination of diaphragm and spermicide, 17 will get pregnant; with a sponge, 11 will get pregnant; and with a cervical cap, 23 will get pregnant.

If you do use these forms of contraceptives, ask your doctor for a prescription for Plan B, which, unfortunately, is not yet available over the counter. If you feel you didn’t use your barrier contraceptive correctly, you can “supplement” Plan B as an emergency measure.

  • How important is STD prevention? You’ll get the most protection from the male condom. None of the other barrier methods have an effect, nor, of course, does an IUD.

Dr. Reichman’s Bottom Line: If you want a non-hormonal contraceptive, there are various over-the-counter or prescribed modes available. Use the above guidelines to figure out which would be best for you, then talk to your doctor.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .